Outcomes and prognostic factors in patients with a single lymph node metastasis at time of radical cystectomy

Michael Rink, Jens Hansen, Eugene K. Cha, David A. Green, Marko Babjuk, Robert S. Svatek, Evanguelos Xylinas, Scott T. Tagawa, Talia Faison, Giacomo Novara, Pierre I. Karakiewicz, Siamak Daneshmand, Yair Lotan, Wassim Kassouf, Hans Martin Fritsche, Armin Pycha, Evi Comploj, Derya Tilki, Patrick J. Bastian, Felix K. ChunRoland Dahlem, Douglas S. Scherr, Shahrokh F. Shariat

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Objectives: To identify clinicopathological factors that predict outcomes in patients with a single lymph node (LN) metastasis (pN1) treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). LN metastasis is an established predictor of clinical outcomes in patients. While most patients with large LN burden experience disease recurrence, lymphadenectomy can be curative in patients with pN1 disease. Patients and Methods: We analysed 381 patients with pN1 UCB from a multi-institutional cohort of 4335 patients with UCB treated with RC and lymphadenectomy without preoperative chemo- or radiotherapy. Subgroup analyses were performed for patients with ≥9 LNs removed and according to adjuvant chemotherapy administration (n = 215). Results: The median (interquartile range, IQR) LN number was 15 (19) and the median (IQR) LN density was 6.7 (7.5)%. Within a median follow-up of 41 months, the mean (+/- sd) 2- and 5-year cancer-specific survival (CSS) rates were 55 (3)% and 46 (3)%, respectively. On multivariable analysis that adjusted for the effects of standard clinicopathological features, female gender (hazard ratio [HR] 1.48, P = 0.023), higher tumour stage (HR 1.68, P = 0.007), positive soft tissue surgical margin (STSM; HR 2.06, P = 0.004), higher LN density (HR 2.99, P = 0.025) and absence of adjuvant chemotherapy (HR 0.70, P = 0.026) were independently associated with CSS. In subgroup analyses of patients with ≥9 LNs removed, tumour stage and STSM status remained independent predictors for CSS (P = 0.009 and P < 0.001, respectively). Conclusions: About half of the patients with pN1 UCB died from UCB within 5 years of RC. Pathological stage and STSM status are strong predictors for outcomes. Accurate prediction of the individual risk of CSS may help risk stratifying pN1 UCB in order to help improve clinical-decision making. Patients with pN1 UCB presenting with additional unfavourable risk factors need a closer follow-up scheduling and might receive adjuvant therapy.

Original languageEnglish (US)
Pages (from-to)74-84
Number of pages11
JournalBJU International
Volume111
Issue number1
DOIs
Publication statusPublished - Jan 2013

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Keywords

  • adjuvant chemotherapy
  • bladder cancer
  • lymph node metastasis
  • nomogram
  • radical cystectomy
  • survival
  • urothelial carcinoma

ASJC Scopus subject areas

  • Urology

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